End-Of-Life Issues Practice Questions

Which client would be most likely to complete an AD? 1. A 65-year-old female who visits her provider yearly. 2. A 34-year-old male licensed practical nurse. 3. A 22-year-old female attending college. 4. A 55-year-old male without a high school diploma.

Answer: 1 1. ADs are most frequently completed by women, whites, married individuals, individuals with a college degree, those individuals in the middle- to upper-socioeconomic class, and those with a chronic disease and regular access to care. This client has the most characteristics of this listed (Rao et al., 2014). 2. Many nurses do not have ADs, although they discuss them with clients daily. 3. Although this client is female, she does not have the most characteristics assigned to clients who complete ADs. 4. ADs are most frequently completed by women, whites, married individuals, individuals with a college degree, middle- to upper-class socioeconomic status, and those with a chronic disease and regular access to care. This client does not have a college degree. TEST-TAKING HINT: If the test taker were not aware of the research, the test taker could examine the characteristics of the clients and ask themselves, "Which client would want to direct care and make decisions?" Nurses may want this, but many do not have ADs.

The client receiving dialysis for end-stage renal disease wants to quit dialysis and die. Which ethical principle supports the client's right to die? 1. Autonomy. 2. Self-determination. 3. Beneficence. 4. Justice.

Answer: 1 1. Autonomy implies the client has the right to make choices and decisions about care, even if it may result in death or is not in agreement with the healthcare team. 2. Self-determination is not an ethical principle. 3. Beneficence is the duty to actively do good for clients. 4. Justice is the duty to treat all clients fairly. TEST-TAKING HINT: The test taker should be aware of ethical principles that mandate a nurse's behavior. Clients have rights, and autonomy is an important principle that the nurse must ensure every client has.

The nurse is admitting a client to the medical-surgical unit. Which is required to be offered to the client if the hospital accepts Medicare reimbursement? 1. The opportunity to make an AD. 2. The client must be referred to a case manager. 3. The client must apply for Medicare supplement insurance. 4. The opportunity to discuss end-of-life issues.

Answer: 1 1. In the 1990s, Congress added the requirement for health-care facilities to offer clients the opportunity to receive an AD form and to be able to complete it to provide the health-care team with knowledge of the clients' wishes. It was added to a Medicare funding bill. 2. The client has to refuse or accept or alert the facility of an intact document about advanced decisions made by the client, but referral to a case manager is not attached to Medicare funding. 3. The client does not have to apply for supplemental insurance. 4. The opportunity may include end-of-life issues, but it is not limited to end of life; it does include issues of irreversible situations and surrogate decision makers. TEST-TAKING HINT: The test taker could eliminate option "3" because the nurse cannot make the client do anything. The client has a right to say no.

The 6-year-old client diagnosed with cystic fibrosis (CF) needs a lung transplant. Which individual would be the best donor for the client? 1. The 20-year-old brother without CF. 2. The 45-year-old father who carries the CF gene. 3. The 18-year-old fatality victim of an MVA matching on 4 points. 4. The 5-year-old drowning victim with a 3-point match.

Answer: 1 1. Living donors are able to donate some organs. The kidneys, a portion of the liver, and a lung may be donated, and the donor will still have functioning organs. An identical twin is the best possible match. However, in the situation in this question, the identical twin would also have CF because the genes would be identical. The next best chance for a compatible match comes from a sibling with both parents in common. 2. The father would have only half of the genetic makeup of the child. 3. There are at least 27 HLA types. A match requires at least 7, and preferably 10 to 11, points. 4. This is not an acceptable match; the client would reject the organ. TEST-TAKING HINT: If the test taker did not know the rationale, then a choice between options "1" and "2" would be the best option because of the direct familial relationships.

Which entity mandates the registered nurse's behavior when practicing professional nursing? 1. The state's Nurse Practice Act. 2. Client's Bill of Rights. 3. The U.S. legislature. 4. American Nurses Association.

Answer: 1 1. Nurse Practice Acts provide the laws that control the practice of nursing in each state. All states have Nurse Practice Acts. 2. The Client's Bill of Rights, also known as "Your Rights as a Hospital Patient," is a document that explains the client's rights to participate in health care; it does not address the nurse's behavior. 3. Each state, not the U.S. Congress, is responsible for writing and implementing the state's Nurse Practice Act. 4. The American Nurses Association is a voluntary organization that provides standards of care and a code of ethics. It addresses issues in nursing, but it does not mandate the registered nurse's behavior. TEST-TAKING HINT: This is a knowledge-based question that the test taker must know.

The client has received a kidney transplant. Which assessment would warrant immediate intervention by the nurse? 1. Fever and decreased urine output. 2. Decreased creatinine and BUN levels. 3. Decreased serum potassium and calcium. 4. Bradycardia and hypotension.

Answer: 1 1. Oliguria, fever, increasing edema, hypertension, and weight gain are signs of organ rejection. 2. A decrease in serum creatinine and BUN would indicate the transplanted kidney is functioning well. 3. Potassium and calcium are not monitored for rejection. 4. The client diagnosed with a fever might have tachycardia. Hypertension is a sign of rejection. TEST-TAKING HINT: Option "2" could be eliminated because of the word "decreased." If the test taker were aware of the role the kidneys play in controlling blood pressure, then option "4" could be eliminated. Decreased urine output in option "1" would make the most sense to choose because the kidneys produce urine.

The HCP has notified the family of a client diagnosed with being in a persistent vegetative state on a ventilator of the need to "pull the plug." The client does not have an AD or a durable power of attorney for health care, and the family does not want their loved one removed from the ventilator. Which action should the nurse implement? 1. Refer the case to the hospital ethics committee. 2. Tell the family they must do what the HCP orders. 3. Follow the HCP's order and "pull the plug." 4. Determine why the client did not complete an AD.

Answer: 1 1. The ethics committee is composed of health-care workers and laypeople from the community to objectively review the situation and make a recommendation that is fair to both the client and the health-care system. The family has the right to be present and discuss their feelings. 2. The nurse is legally obligated to be a client advocate. 3. This action could create a multitude of ramifications, including a lawsuit and possible criminal charges. 4. It really doesn't matter at this point why the client didn't complete an AD; the client cannot do it now. TEST-TAKING HINT: The test taker must be aware of the ethics committee and its role in helping resolve ethical dilemmas. Any answer option that has the word "why" should be evaluated closely before selecting it as the correct answer. Removing the endotracheal tube or turning off the ventilator ("pulling the plug") is a medical responsibility; therefore, option "3" could be eliminated as the correct answer.

The nurse is caring for an 82-year-old female client crying and asking for her mother to come to see her. Which statement represents the ethical principle of nonmaleficence? 1. "You must miss your mother very much. Can you tell me about her?" 2. "You are 82 years old. Your mother is dead and can't come to see you." 3. "Why do you need your mother? Can I get something for you?" 4. "Your mother would not want you to worry. I will tell her you want to see her."

Answer: 1 1. The nurse is caring for a client who is at best disoriented; challenging this cognitive deficiency will only create frustration and anxiety in the client. Nonmaleficence is the duty to prevent or do no harm. This is a therapeutic response that validates the client's concern but does not include lying to the client. 2. This is veracity, to tell the truth. 3. The client does not owe the nurse an explanation of why she wishes to see her mother. "Why" is not appropriate in this situation. 4. This is the opposite of veracity; it is lying to the client. If the nurse believes the client's mother to be dead, then how will the nurse contact her? TEST-TAKING HINT: The test taker could eliminate option "2" because it is veracity and "4" because it is lying.

The client is on the ventilator and has been declared brain dead. The spouse refuses to allow the ventilator to be discontinued. Which collaborative action by the nurse is most appropriate? 1. Discuss the referral of the case to the ethics committee. 2. Pull the plug when the spouse is not in the room. 3. Ask the HCP to discuss the futile situation with the spouse. 4. Inform the spouse what is happening is cruel.

Answer: 1 1. The nurse should discuss using the ethics committee with the HCP to assist the family in making the decision to terminate life support. Many families feel there may be a racial or financial reason the HCP wants to discontinue life support. 2. This would be an illegal act on the part of the nurse and would destroy the nurse-client relationship with the family. 3. The stem already indicates the spouse is aware of the situation. 4. This is expressing a personal bias on the part of the nurse. TEST-TAKING HINT: The test taker could eliminate option "2" based on the legal and ethical issues. Option "3" is asking the HCP to do something that has already been done.

The nurse writes a client problem of "spiritual distress" for the dying client. Which statement is an appropriate goal? 1. The client will reconcile himself and the higher power of personal beliefs. 2. The client will be able to express anger at the terminal diagnosis. 3. The client will reconcile himself to estranged members of the family. 4. The client will have a dignified and pain-free death.

Answer: 1 1. The primary goal of spiritual care is to allow the client to be able to reconcile with a higher being, maybe God. This goal is based on the belief that life comes from God, and to some degree, for many people the process of living includes some separation from God. 2. This could be a goal for a diagnosis of anger, but it does not recognize the spiritual aspect of the client. 3. This would be a goal for altered family functioning. 4. This is the physiological goal for any client who is dying, but it is not a goal for spiritual distress. TEST-TAKING HINT: The identified problem is "spiritual distress," and the goal must have information that addresses the spiritual. This would eliminate option "4." Personal relationships with family members (option "3") could also be eliminated.

The spouse of a client dying from lung cancer states, "I don't understand this death rattle. She has not had anything to drink in days. Where is the fluid coming from?" Which is the hospice care nurse's best response? 1. "The body produces about 2 teaspoons of fluid every minute on its own." 2. "Are you sure someone is not putting ice chips in her mouth?" 3. "There is no reason for this, but it does happen from time to time." 4. "I can administer a patch to her skin to dry up the secretions if you wish."

Answer: 1 1. The respiratory tract cells produce liquid as a defense mechanism against bacteria and other invaders. About 9 mL a minute are produced. The "death rattle" can be disturbing to family members; the nurse should intervene, but not with suctioning, which will increase secretions and the need to suction more. 2. This is a natural physical phenomenon and should be addressed. 3. There is an explanation. 4. The scopolamine patch applied to the skin helps to limit the secretions, but this does not answer the question. TEST-TAKING HINT: The test taker could eliminate option "3" because it states there is no reason, option "4" because it does not answer the question, and option "2" because it is attempting to fix blame.

The nurse is obtaining the client's signature on a surgical permit form. The nurse determines the client does not understand the surgical procedure and possible risks. Which action should the nurse take first? 1. Notify the client's surgeon. 2. Document the information in the EHR. 3. Contact the operating room staff. 4. Explain the procedure to the client.

Answer: 1 1. The surgeon is responsible for explaining the surgical procedure to the client; therefore, the nurse should first notify the surgeon. 2. This information should be documented in the EHR, but it is not the first intervention. 3. The operating room staff may or may not need to be notified based on when or if the permit is being signed, but it is not the first intervention. 4. The nurse is not responsible for explaining the surgical procedure. The nurse is responsible for making sure the client understands and for obtaining the consent. TEST-TAKING HINT: The nurse is responsible for getting the permit signed and in the EHR before going to surgery, but the nurse is not responsible for explaining the procedure to the client.

The experienced medical-surgical nurse is being oriented to the transplant unit. Which client should the charge nurse assign to this nurse? 1. The client who donated a kidney to a relative 3 days ago and will be discharged in the morning. 2. The client who had a liver transplantation 3 days ago and was transferred from the intensive care unit 2 hours ago. 3. The client who received a corneal transplant 4 hours ago and has developed a cough and is vomiting. 4. The client who had pancreas transplantation and who has a fever, chills, and a blood glucose monitor reading of 342.

Answer: 1 1. This client is ready for discharge and is presumably stable. The client donated the kidney and still has one functioning kidney. An experienced medical-surgical nurse could care for this client. 2. This client must be observed closely for rejection of the organ and is newly transferred from the intensive care unit; therefore, a more experienced nurse in transplant care should care for this client. 3. This client has developed symptoms of a problem unrelated to the corneal transplant, but these symptoms will increase intracranial pressure, resulting in indirect pressure to the cornea. Therefore, a more experienced transplant nurse should care for this client. 4. This client is showing symptoms of organ rejection, which is a medical emergency and requires a more experienced transplant nurse. TEST-TAKING HINT: The test taker should choose the client with the fewest potential problems. The nurse is experienced as a medical-surgical nurse, but transplant recipients require more specialized knowledge.

The nurse is caring for the family of the deceased client. Which is the nurse's priority action? 1. Be with the family. 2. Call the funeral home. 3. Notify the minister. 4. Fill out the death certificate.

Answer: 1 1. When a death occurs, the need is for the nurse's presence; just being there with the family is what will help the family grieve. 2. The nurse may need to notify the funeral home, but the family is the priority need. 3. If the family wants the minister to be called, the nurse could do this, but frequently, the family has a relationship with the minister and will need to speak directly with the minister to arrange the services. 4. The death certificate is completed by the physician signing it, not the nurse. TEST-TAKING HINT: The test taker could eliminate all options besides "1" because none of these will assist the grieving process.

The nurse is caring for a client who received a kidney transplant from an unrelated cadaver donor. Which interventions should be included in the plan of care? Select all that apply. 1. Collect a urine culture every other day. 2. Prepare the client for dialysis three times a week. 3. Monitor urine osmolality studies. 4. Monitor intake and output every shift. 5. Check abdominal dressing every 4 hours.

Answer: 1, 2 1. Urine cultures are performed frequently because of the bacteriuria present in the early stages of transplantation. 2. A cadaver kidney may have undergone acute tubular necrosis and may not function for 2 to 3 weeks, during which time the client may experience anuria, oliguria, or polyuria and require dialysis. 3. Serum creatinine and BUN levels are monitored, but there is no need to monitor the urine osmolality. 4. Hourly outputs are monitored and compared with the intake of fluids. 5. The dressing is a flank dressing. TEST-TAKING HINT: The test taker should notice time frames. Anytime a specific time reference is provided, the test taker must determine if the time frame is the appropriate interval for performing the activity. In option "4," "every shift" is not appropriate.

The hospice care nurse is planning the care of an older client diagnosed with end-stage renal disease. Which interventions should be included in the plan of care? Select all that apply. 1. Discuss financial concerns. 2. Assess any comorbid conditions. 3. Monitor increased visual or auditory abilities. 4. Note any spiritual distress. 5. Encourage euphoria at the time of death.

Answer: 1, 2, 4 1. Older clients are frequently on fixed incomes, and financial concerns are important for the nurse to address. A social services referral may be needed. 2. Older clients may have many comorbid conditions, which affect the type and amount of medications the client can tolerate and the client's quality of life. 3. Visual and auditory senses decrease with age; they do not increase. 4. The client may feel some spiritual distress at the terminal diagnosis. Even if the client possesses a strong faith, the unknown can be frightening. 5. A type of euphoria may accompany dehydration before death. This is a natural physiological occurrence the nurse should recognize, but it is not an intervention the nurse can implement. TEST-TAKING HINT: The test taker can decide on three of the answer options based on the descriptive word "elderly." Option "5" is not a nursing intervention.

The nurse is orienting to a hospice organization. Which statements describe the rights of the terminal client? Select all that apply. 1. Be treated with respect and dignity. 2. Have particulars of the death withheld. 3. Receive optimal and effective pain management. 4. Receive holistic and compassionate care. 5. Choose the attending physician.

Answer: 1, 3, 4, 5 1. The client has the right to be cared for with respect and dignity. 2. The client has the right to discuss feelings and direct care. Withholding information would be lying to the client. 3. The client has the right to the best care available and to have pain treated, regardless of the potential for hastening death. 4. All clients, even if they are not dying, have the right to holistic and compassionate care. 5. Clients have a right to choose their attending physician or HCP without undue influence from the hospice organization. TEST-TAKING HINT: This is an alternative format question. The test taker should select more than one option as correct and must select all appropriate options to receive credit for a correct answer. There are no partially correct answers.

Which elements are necessary to prove nursing malpractice? Select all that apply. 1. Duty to the client. 2. Identification of an ethical issue. 3. Failure to follow the standard of care. 4. Injury to the client. 5. Proximate cause.

Answer: 1, 3, 4, 5 1. The duty to the client must be established. The nurse assumes a legal duty by accepting to care for the client. Establishing duty to the client is one of the four elements necessary to prove nursing malpractice. It is a failure to perform according to the established standard of conduct. 2. This is one of the four steps in ethical decision making. It is not an element necessary to prove nursing malpractice. 3. Failure to perform according to the established standards of care is necessary to prove nursing malpractice. 4. Breach of duty resulting in an actual injury or damage to the client is required to prove nursing malpractice. 5. A connection must exist between conduct and the resulting injury to prove nursing malpractice. TEST-TAKING HINT: This is a knowledge-based question, but the test taker should realize that ethical issues and legal issues are two different concerns and that malpractice is a legal concern. The test taker should also know the four elements necessary to prove nursing malpractice: (1) The nurse has a duty to the client. (2) The duty has been breached. The nurse failed to uphold a standard of care. (3) There is some harm to the client. (4) The breach of duty caused the harm.

The nurse is aware of the Patient Self-Determination Act (PSDA) of 1991 requires the health-care facility to implement which action? Select all that apply. 1. Make available an AD on admission to the facility. 2. Assist the client with legally completing a will. 3. Provide ethically and morally competent care to the client. 4. Educate the facility staff about ADs. 5. Discuss the importance of understanding consent forms.

Answer: 1, 4 1. The PSDA of 1991 requires health-care facilities that receive Medicare or Medicaid funding to make ADs available to clients on admission into the facility. 2. This act is not concerned with completing a legal will. 3. Client care is not based on this act. 4. The PSDA requires that health-care facilities educate their staff about ADs. 5. Consent forms are legal documents, which are not discussed in this act. TEST-TAKING HINT: The test taker should examine the word "self-determination" in the stem of the question, which matches the AD in option "1." Also, the facility should ensure the staff is familiar with all federal laws impacting the care of a client. The words "legally," "ethically," and "morally" in options "2" and "3" apply to the nurse in the health-care setting, not the client.

The client has been in a persistent vegetative state for several years. The family, having decided to withhold tube feedings because there is no hope of recovery, asks the nurse, "Will the death be painful?" Which intervention should the nurse implement? 1. Tell the family that death will be painful, but the HCP can order medications. 2. Inform the family dehydration provides a type of natural euphoria. 3. Relate other cases where the clients have died in excruciating pain. 4. Ask the family why they are concerned because they want the client to die anyway.

Answer: 2 1. Death from dehydration occurs when the client is unable to take in fluids, but dehydration is not painful. 2. Death from dehydration occurs when the client is unable to take in fluids. A natural euphoria occurs with dehydration. This is the body's way of allowing comfort at the time of death. 3. This is needless. 4. Families who make this decision tend to do so from a deep sense of love and commitment. It is an extremely difficult decision to make, and the nurse should not condemn the family decision. TEST-TAKING HINT: The test taker could examine options "3" and "4" and eliminate them based on the needless information or the nurse stepping outside of professional boundaries.

The client diagnosed with chronic back pain is being placed on a transcutaneous electrical nerve stimulation (TENS) unit. Which information should the nurse teach? Select all that apply. 1. The TENS unit can be controlled by the client adjusting the intensity. 2. The TENS unit will deaden the nerve endings, and the client will not feel pain. 3. The TENS unit could cause paralysis if the client gets the unit wet. 4. The TENS unit stimulates the nerves in the area, blocking the pain sensation. 5. The TENS unit should be left on for an hour and then taken off for an hour.

Answer: 1, 4 1. The TENS unit has a dial allowing the client to adjust the intensity of the electrical stimulation. 2. The TENS unit does not deaden nerve endings; this would be accomplished through local anesthesia. 3. The unit could stop functioning if it got wet, but this would not cause paralysis. 4. The TENS unit works on the gate control theory of pain control and works by flooding the area with stimulation and blocking the pain impulses from reaching the brain. 5. The TENS unit should be applied and left in place unless the client is showering. TEST-TAKING HINT: A medical device that causes paralysis so easily would not be approved for use by the general population, so option "2" could be eliminated. The test taker would need to be aware of the gate control theory of pain control to select option "4." The test taker should be familiar with how a TENS unit operates.

The client is being discharged from the hospital for intractable pain secondary to cancer and is prescribed morphine. Which statements indicate the client understands the discharge instructions? Select all that apply. 1. "I will be sure to have my prescriptions filled before any holiday." 2. "There should not be a problem having the prescriptions filled anytime." 3. "If I run out of medications, I can call the HCP to phone in a prescription." 4. "There are no side effects to morphine I should be concerned about." 5. "I can get only a 30-day supply of the prescription morphine."

Answer: 1, 5 1. Narcotic medications require a prescription handwritten in ink or typewritten and manually signed by the practitioner (Drug Enforcement Administration, n.d.). Many local pharmacies will not have the medication available or may not have it in the quantities needed. The client should anticipate the needs before any time when the HCP may not be available or the pharmacy may be closed. 2. There can be several reasons a legitimate prescription is not filled. 3. In most cases, morphine, an opioid, needs a handwritten or typewritten prescription that is manually signed by the practitioner. Telephone orders are only permitted in emergency situations. 4. All medications have side effects; most notably, narcotics slow peristalsis and cause constipation. 5. Although federal regulations do not limit quantities of drugs dispensed with a prescription, many states and insurance carriers limit the quantity of a controlled substance to a 30-day supply. TEST-TAKING HINT: The test taker could eliminate options "1" and "2" because they are opposites. Option "4" is untrue of all medications. The test taker should be familiar with prescription requirements for opioids.

The client is in the psychiatric unit in a medical center. Which actions by the psychiatric nurse are violations of the client's legal and civil rights? Select all that apply. 1. The nurse tells the client to wear a hospital gown in the unit. 2. The nurse allows the client to have family visits during visiting hours. 3. The nurse permits the client to eat food family members brought from home. 4. The nurse delivers unopened mail and packages to the client. 5. The nurse listens to the client talking on the telephone to a friend.

Answer: 1, 5 1. This is a violation of the client's rights. The civil rights of clients include the right to wear their own clothes, keep personal items, and have a small amount of money in a psychiatric unit. 2. Seeing visitors is the civil right of the client. 3. Clients are allowed to eat food brought from home by family members. 4. Receiving and sending unopened mail is a civil right of the client, but any packages must be inspected when the client is opening them to check for sharp items, weapons, or any type of medication. 5. This is a violation of the client's rights. The client has a right to have reasonable access to a telephone and the opportunity to have private conversations by telephone. TEST-TAKING HINT: The test taker must be aware of the client's legal and civil rights. The client in the psychiatric unit has the same rights as the client in the medical unit. Clients in a psychiatric hospital do not have to wear hospital gowns; they can wear their own clothes.

The client tells the nurse, "Every time I come to the hospital you hand me one of these advance directives (ADs). Why should I fill one of these out?" Which statement by the nurse is most appropriate? 1. "You must fill out this form because Medicare laws require it." 2. "An AD lets you participate in decisions about your health care." 3. "This paper will ensure no one can override your decisions." 4. "It is part of the hospital admission packet, and I have to give it to you."

Answer: 2 1. ADs are not legally required. It is a standard of the Joint Commission, and any facility that accepts federal funds must ask and offer the AD. 2. ADs allow the client to make personal health-care decisions about end-of-life issues, including cardiopulmonary resuscitation (CPR), ventilators, feeding tubes, and other issues concerning the client's death. 3. This is not a legal document guaranteed to stand up in a court of law; therefore, the client should make sure all family members know the client's wishes. 4. It is part of the hospital admission requirements, but it is not the reason why the client should complete an AD. TEST-TAKING HINT: The test taker could eliminate option "1" because the nurse cannot make the client do anything. The client has a right to say no. Option "3" is an absolute, and unless the test taker knows for sure this is correct information, the test taker should not select this option.

The nurse and a UAP are caring for clients on a postoperative transplant unit. Which task should the RN delegate to the UAP? 1. Assess the hourly outputs of the post-kidney transplantation client. 2. Raise the head of the bed for a post-liver transplantation client. 3. Monitor the serum blood studies of a rejected organ transplant client. 4. Irrigate the nasogastric tube of a pancreas transplant client.

Answer: 2 1. Assessment is always the nurse's responsibility and cannot be delegated. Hourly outputs are monitored to determine kidney function. 2. The UAP can perform this function. There is no nursing judgment required. 3. This requires nursing judgment and is outside the UAP's expertise. 4. Irrigating a nasogastric tube for a client who has undergone a pancreas transplant should be done by the nurse; this is a high-level nursing task. TEST-TAKING HINT: When asked to choose a task that can be delegated, the test taker should determine which task requires the least amount of judgment and choose that option.

The nurse is discussing placing the client diagnosed with chronic obstructive pulmonary disease in hospice care. Which prognosis must be determined to place the client in hospice care? 1. The client is doing well but could benefit from the added care by hospice. 2. The client has a life expectancy of 6 months or less. 3. The client will live for about 1 to 2 more years. 4. The client has about 8 weeks to live and needs pain control.

Answer: 2 1. Hospice care does not assume care of a client with a prognosis of more than 6 months and who is doing well. 2. The HCP must think that, without life-prolonging treatment, the client has a life expectancy of 6 months or less. The client may continue receiving hospice care if the client lives longer. 3. The client may live this long, but the HCP must think life expectancy is much shorter. 4. Hospice will attempt to manage symptoms of pain, nausea, and any other discomfort the client is experiencing, but the life expectancy is 6 months. TEST-TAKING HINT: This is a knowledge-based question requiring an understanding of hospice.

The client diagnosed with septicemia has died. The family tells the nurse the client is an organ donor. Which intervention should the nurse implement? 1. Notify the organ and tissue organizations to make the retrieval. 2. Explain a systemic infection prevents the client from being a donor. 3. Call and notify the HCP of the family's request. 4. Take the body to the morgue until the organ bank makes a decision.

Answer: 2 1. Many states require tissue and organ banks to be notified of all deaths, but the systemic infection eliminates this client from becoming a donor. 2. Septicemia is a systemic infection and will prevent the client from donating tissues or organs. 3. There is no reason to notify the HCP. 4. If the client were to be an organ donor, then the client's body would remain in the intensive care unit on the ventilator and with IV medication support until the organ bank team arrives and takes the client to the operating room. TEST-TAKING HINT: Option "3" could be eliminated from consideration because the nurse should be able to handle this situation. Option "4" could be eliminated because the client would have to stay on life support if the organ bank were to retrieve viable organs.

The client diagnosed with cancer is experiencing severe pain. Which regimen would the nurse teach the client about to control the pain? 1. NSAIDs around the clock with narcotics used for severe pain. 2. Morphine, sustained release, routinely with a liquid morphine preparation for breakthrough pain. 3. Extra-strength acetaminophen plus therapy to learn alternative methods of pain control. 4. Meperidine every 6 hours orally with a suppository when the pain is not controlled.

Answer: 2 1. NSAIDs around the clock are dangerous because of the potential for gastrointestinal ulceration. NSAIDs are not the drug of choice for cancer pain. 2. Opioids, such as morphine, are the drug of choice for cancer pain. There is no ceiling effect, it metabolizes without harmful by-products, and it is relatively inexpensive. A sustained-release formulation, such as MS Contin, can be administered every 6 to 8 hours, and a liquid fast-acting form is administered sublingually for any pain that is not controlled. 3. Extra-strength acetaminophen (Tylenol), a nonnarcotic analgesic, is not strong enough for this client's pain. The maximum adult dose within a 24-hour period is 4 g. Extra-strength Tylenol is toxic to the liver in higher amounts. 4. Meperidine (Demerol), an opioid narcotic, metabolizes into normeperidine and is not cleared by the body rapidly. A buildup of normeperidine can cause the client to seize. TEST-TAKING HINT: The test taker must be aware of medications and their uses.

The client has just signed an AD at the bedside. Which intervention should the nurse implement first? 1. Notify the client's HCP about the AD. 2. Instruct the client to discuss the AD with significant others. 3. Scan a copy of the advance directive into the client's EHR. 4. Give the original AD to the client.

Answer: 2 1. The HCP should be made aware of the AD, but this is not the first intervention. 2. This is the most important intervention because the legality of the document is sometimes not honored if the family members disagree and demand other actions. If the client's family is aware of the client's wishes, then the health-care team can support and honor the client's final wishes. 3. Copies of the AD should be placed in the EHR and given to significant others, the client's attorney, and all HCPs. 4. The original should be given to the client, and a copy should be placed in the EHR, but this is not the first intervention. TEST-TAKING HINT: This is a priority-setting question, and the test taker should read all the answer options and try to rank them in order of priority.

The male client has a DNR order in the EHR and is in pain. The client's vital signs are populated in the vital sign flowsheet below. Which intervention should be the nurse's priority action? - BP: 108/70 - Pulse: 88 - Respirations: 8 1. Refuse to give the medication because it could kill the client. 2. Administer the medication as ordered and assess for relief from pain. 3. Wait until the client's respirations improve and then administer the medication. 4. Notify the HCP the client is unstable, and pain medication is being held.

Answer: 2 1. The client is in pain and has the right to have pain-control measures taken. 2. The client is in pain. The American Nurses Association Code of Ethics (2015) states clients have the right to die as comfortably as possible even if the measures used to control the pain indirectly hasten the impending death. The Dying Client's Bill of Rights reiterates this position. The client should be allowed to die with dignity and with as much comfort as the nurse can provide. 3. The client may be splinting to prevent the pain from being too severe. The client's respirations actually may improve when the nurse administers the pain medication. 4. The HCP is aware the client is unstable because the HCP must write the DNR order on the EHR. There is no reason to withhold the needed medication. TEST-TAKING HINT: The position of administering medication that could hasten a client's death is a difficult one and requires the nurse to be aware of ethical position statements. Nurses never administer medications for the purpose of hastening death but sometimes must administer medications to provide the best comfort.

Which act protects the nurse against a malpractice claim when the nurse stops at a motor vehicle accident and renders emergency care? 1. The Health Insurance Portability and Accountability Act. 2. The State Nurse Practice Act. 3. The Emergency Rendering Aid Act. 4. The Good Samaritan Act.

Answer: 4 1. HIPAA is a federal act protecting the client's privacy while receiving health care. 2. The state Nurse Practice Acts provide the laws that control the practice of nursing in each state. 3. There is no such law as this act. 4. The Good Samaritan Act protects HCPs against malpractice claims for care provided in emergency situations. TEST-TAKING HINT: The test taker should be knowledgeable regarding the Good Samaritan Act and its implications in the nurse's professional career. The NCLEX-RN® often asks questions on this act.

The nurse is discussing malpractice issues in an in-service class. Which situation is an example of malpractice? 1. The nurse fails to report a neighbor abusing his two children. 2. The nurse does not intervene in a client with a BP of 80/50 and an apical pulse of 122. 3. The nurse is suspected of taking narcotics prescribed for a client. 4. The nurse falsifies vital signs in the client's medical records.

Answer: 2 1. The law states child abuse or suspected child abuse must be reported. The nurse is legally responsible for reporting child abuse or suspected child abuse. This is a legal issue, not malpractice. 2. Malpractice is a failure to meet the standards of care that results in harm to or death of a client. Failing to heed warnings of shock is an example of malpractice. 3. Stealing narcotics is a legal situation, not a malpractice issue. The nursing license could be revoked for this illegal behavior. 4. Falsifying documents is against the law. It is not a malpractice issue. TEST-TAKING HINT: The test taker must be knowledgeable regarding malpractice. Legal issues are dealt with by the laws of the state and federal government, and malpractice issues are dealt with in the state Nurse Practice Acts.

The client in the oncology clinic tells the nurse she has a great deal of pain but does not like to take pain medication. Which action should the nurse implement first? 1. Tell the client it is important to take the medication. 2. Find out how the client has been dealing with the pain. 3. Have the HCP tell the client to take the pain medications. 4. Instruct the client not to worry—the pain will resolve itself.

Answer: 2 1. This could be appropriate once the nurse assesses the situation further. 2. The nurse should assess the situation fully. The client may be afraid of becoming addicted or may have been using alternative forms of treatment, such as music therapy, distraction techniques, acupuncture, or guided imagery. 3. This is not appropriate. It is in the nurse's realm of responsibility to investigate the client's reasons for not wanting to take pain medication. 4. Chronic cancer pain does not resolve on its own. TEST-TAKING HINT: Option "1" is advising without assessing. Assessment is the first step of the nursing process and should be implemented first in most situations unless a direct intervention treats the client in an emergency.

The charge nurse is making assignments on an oncology floor. Which client should be assigned to the most experienced nurse? 1. The client diagnosed with leukemia and has a hemoglobin of 6 g/dL. 2. The client diagnosed with lung cancer with a pulse oximeter reading of 89%. 3. The client diagnosed with colon cancer who needs the colostomy irrigated. 4. The client diagnosed with Kaposi's sarcoma and is yelling at the staff.

Answer: 2 1. This hemoglobin is low but would be expected for a client diagnosed with leukemia. A less-experienced nurse could care for this client. Leukemia affects the production of all cells produced by the bone marrow—either there is too much production of immature cells overpowering the ability of the bone marrow to use the pluripotent cells to produce other needed blood cells or because the bone marrow is not producing enough cells as needed. It effectively produces pancytopenia. 2. This represents an arterial blood gas of less than 60%; this client should be assigned to the most experienced nurse. 3. A client who needs a colostomy irrigated could be assigned to a less-experienced nurse. 4. Psychological problems come second to physiological ones. TEST-TAKING HINT: This is a priority question. The test taker should realize option "1" is expected and may even be good for this client; option "3" is expected and not life-threatening; and option "4," although not expected, is not life-threatening. By doing this, the test taker could then look at what was determined for each option and realize option "2" needs the most experienced nurse.

Which situation would cause the nurse to question the validity of an AD when caring for the older client? 1. The client's child insists the client make decisions. 2. The nurse observes the wife making the spouse sign the AD. 3. A nurse encouraged the client to think about end-of-life decisions. 4. A friend witnesses the client's signature on the AD form.

Answer: 2 1. This is appropriate for completing an AD and would not make the nurse question the validity of the AD. 2. This is coercion and is illegal when signing an AD. The AD must be signed by the client's own free will; an AD signed under duress may not be valid. 3. The nurse encouraging the client to think about ADs is an excellent intervention and would not make the AD invalid. 4. A friend can sign the AD as a witness; this would not cause the nurse to question its validity. TEST-TAKING HINT: This is an "except" question. The test taker could ask, "Which situation is valid for an AD?" Remember, three answers are valid information for the AD and only one is not. The test taker should read all answer options and not jump to conclusions.

The nurse is teaching an in-service on legal issues in nursing. Which situations are examples of battery, an intentional tort? Select all that apply. 1. The nurse threatens the client refusing to take a hypnotic medication. 2. The nurse forcibly inserts a Foley catheter in a client refusing it. 3. The nurse tells the client a nasogastric tube insertion is not painful. 4. The nurse gives confidential information over the telephone. 5. The nurse pushes the client out of the bed after the client says "no."

Answer: 2, 5 1. This is an example of assault, which is a mental or physical threat without touching the client. 2. When a mentally competent adult is forced to have a treatment that has been refused, battery occurs. 3. This is fraud, a willful and purposeful misrepresentation that could cause harm to a client. 4. This is called "defamation," a divulgence of privileged information or communication. This is a violation of the Health Insurance Portability and Accountability Act (HIPAA). 5. When a mentally competent adult is forced to perform an action the client has refused, this is battery, even if it did not result in physical harm to the client. TEST-TAKING HINT: If the test taker knows battery is "bad," it may lead to selecting option "2" and option "5" because both indicate the patient has refused the treatment or action. The test taker could attempt to eliminate options based on knowledge. For example, breaking confidentiality is a violation of HIPAA; thus option "4" can be eliminated.

The client diagnosed with intractable pain is receiving an IV constant infusion of morphine. The concentration is 50 mg of morphine in 250 mL of normal saline. The IV is infusing at 10 mL/hr. The client has required bolus administration of 2 mg IV push (IVP) × 2 during the 12-hour shift. How much morphine has the client received during the shift? mg

Answer: 28 mg of morphine First, determine how many milligrams of morphine, a narcotic opioid, are in each milliliter of saline: 50 ÷ 250 mL = 0.2 mg/mL Then determine how many milliliters are given in a shift: 10 mL/hr × 12 hour = 120 mL infused 1 shift = 120 mL infused If each milliliter contains 0.2 mg of morphine, then 0.2 mg × 120 mL = 24 mg by constant infusion Then determine the amount given IVP: 2 × 2 = 4 mg given IVP Finally, add the bolus amount to the amount constantly infused: 24 + 4 = 28 mg TEST-TAKING HINTS: The nurse is responsible for being knowledgeable regarding all medications and the amount the client is receiving. The test taker can use the drop-down calculator on the NCLEX-RN® examination or ask the examiner for scratch paper.

In which client situation would the AD be consulted and used in decision making? 1. The client diagnosed with Guillain-Barré on a ventilator. 2. The client diagnosed with a C6 spinal cord injury in the rehabilitation unit. 3. The client diagnosed with end-stage renal disease in a comatose state. 4. The client with Down syndrome and diagnosed with cancer.

Answer: 3 1. A client diagnosed with Guillain-Barré syndrome is mentally competent, and being on a ventilator does not indicate the client has lost decision-making capacity. 2. A client in the rehabilitation unit would be alert, and spinal cord injuries do not cause the client to lose decision-making capacity. 3. The client must have lost decision-making capacity as a result of a condition that is not reversible or must be in a condition specified under state law, such as a terminal, persistent vegetative state; an irreversible coma; or as specified in the AD. 4. A client diagnosed with Down syndrome may have some intellectual challenges, but unless the client has been declared legally incompetent in a court of law, the client can complete an AD and participate in care. TEST-TAKING HINT: If the test taker knows what an AD is, then the words "end-stage" and "comatose" would lead the test taker to select option "3" as a correct answer. Remember, clients with congenital or genetic disorders are not incompetent, even if they are mentally challenged.

The nurse pronounced Dr. Smith's client to be clinically dead. Which should the RN document in the client's EHR? 1. Brain scan indicates no brain wave activity; the client pronounced deceased. The family refuses to talk with the organ bank. 2. Cardiac arrest noted, CPR initiated but unsuccessful. Pronounced dead. 3. Pulse, respirations, and blood pressure absent at 0900, pronounced dead. Dr. Smith to sign death certificate. 4. Client found without a pulse, body cold to touch. Pronounced deceased at 0900.

Answer: 3 1. Clinical death is the absence of pulse, respirations, and blood pressure. It does not include radiology or other diagnostic tests. 2. If CPR is unsuccessful, the nurse cannot pronounce death. A physician must determine the reason for the death. 3. For it to be legal for a nurse to pronounce death, the client must have a disease process that could lead to death. The physician must write a clear order that the nurse can pronounce and be willing to document the cause of death on the death certificate. The observed clinical signs must be documented and the time pronounced. 4. This is an incomplete entry. TEST-TAKING HINT: The test taker could eliminate option "1" because clinical death is the absence of clinical signs of life. Option "3" is complete documentation; the nurse states the facts without embellishment in the documentation.

The male client requested a DNR per the AD, and the HCP wrote the order. The client's death is imminent, and the client's spouse tells the nurse, "Help him, please. Do something. I am not ready to let him go." Which action should the nurse take? 1. Ask the spouse if she would like to revoke her husband's AD. 2. Leave the spouse at the bedside and notify the hospital chaplain. 3. Sit with the spouse at the bedside and encourage her to say good-bye. 4. Request the client to tell the spouse he is ready to die, and don't do anything.

Answer: 3 1. Only the client can revoke the AD. 2. The spouse should not be left alone, and the hospital chaplain may not be available for the client and his spouse. 3. At the time of death, loved ones become scared and find it difficult to say good-bye. The nurse should support the client's decision and acknowledge the spouse's psychological state. Research states hearing is the last sense to go, and talking to the dying client is therapeutic for the client and the family. 4. The client is dying and should not be asked to exert himself for his wishes to be carried out. TEST-TAKING HINT: Logic would suggest option "4" is not a viable answer. Leaving a grieving spouse would not be appropriate in any situation; therefore, the test taker should eliminate option "2." Option "1" denies the client's autonomy and is not an ethical or a legal choice.

The client had a mastectomy and lymph node dissection 3 years ago and has experienced post-mastectomy pain syndrome (PMPS) since. Which intervention should the nurse implement? 1. Have the client see a psychologist because the pain is not real. 2. Tell the client that the pain is cancer coming back. 3. Refer the client to a physical therapist to prevent a frozen shoulder. 4. Discuss changing the client to a more potent narcotic medication.

Answer: 3 1. Pain is whatever the client says it is and occurs whenever the client says it does. The nurse should never deny the client's pain exists. 2. This has been occurring for the past 3 years and does not mean cancer has come back. Many clients will fear cancer has recurred and delay treatment; denial is a potent coping mechanism. 3. PMPS is characterized as a constriction accompanied by a burning sensation or prickling in the chest wall, axilla, or posterior arm resulting from movement of the arm. The pain can cause the client to limit movement of the arm and the shoulder, resulting in a frozen shoulder, also known as adhesive capsulitis of the shoulder. 4. There are many problems associated with long-term narcotic use. Other strategies should be attempted before resigning the client to a lifetime of taking narcotic medications. TEST-TAKING HINT: The test taker could eliminate option "1" because it violates all principles of pain management. Option "2" is not in the realm of the nurse's responsibility.

The nurse is discussing the HCP's recommendation for removal of life support with the client's family. Which information concerning brain death should the RN teach the family? 1. Positive waves on the electroencephalogram (EEG) mean the brain is dead and any further treatment is futile. 2. When putting cold water in the ear, if the client reacts by pulling away, this demonstrates brain death. 3. Tests will be done to determine if any brain activity exists before the machines are turned off. 4. Although the blood flow studies don't indicate activity, the client can still come out of the coma.

Answer: 3 1. Positive brain waves on the EEG indicate brain activity, and the client is not brain dead. 2. This is called the oculovestibular test. If the client reacts, then it indicates brain activity and the client is not brain dead. 3. The Uniform Determination of Brain Death Act states brain death is determined by accepted medical standards, which indicate irreversible loss of all brain function. Cerebral blood flow studies, EEG, and oculovestibular and oculocephalic tests may be done. 4. If the cerebral blood flow studies do not show acceptable blood flow to the brain, the client will not come out of the vegetative state. TEST-TAKING HINT: If the test taker examined all answer options and did not understand options "1," "2," and "4," then reading option "3" again would prove it to be the best choice because it simply states the machine won't be turned off until brain death has been proved.

The client is 3 hours post-heart transplantation. Which data would support a complication of this procedure? 1. The client has nausea after taking oral antirejection medication. 2. The client has difficulty coming off the heart-lung bypass machine. 3. The client has saturated three abdominal dressing pads in 1 hour. 4. The client reports pain at a "6" on a 1-to-10 scale.

Answer: 3 1. The client would be NPO at this time and would be receiving parenteral antirejection medications. 2. The client would have been taken off the heart-lung bypass machine in the operating room. 3. Saturating three dressing pads in 1 hour would indicate hemorrhage. 4. Pain is expected and is not a complication of the procedure. TEST-TAKING HINT: The test taker should notice the time frame provided in the stem—in this case, 3 hours after surgery. This could eliminate options "1" and "2."

The family is dealing with the imminent death of the client. Which information is most important for the nurse to discuss when planning interventions for the grieving process? 1. How angry are the family members about the death? 2. Which family member will be making decisions? 3. What previous coping skills have been used? 4. What type of funeral service has been planned?

Answer: 3 1. The family may or may not be angry, and this would need to be addressed, but it is not the most important. 2. Who makes the decisions is not as important as discovering which coping skills the family uses when under stress. 3. The nurse should assess previous coping skills used by the family and build on those to assist the family in dealing with their loss. Coping mechanisms are learned behaviors and should be supported if they are healthy behaviors. If the client and family use unhealthy coping behaviors, then the nurse should attempt to guide the family to a counselor or support group. 4. The type of funeral service may help the family to grieve, but it is not the most important intervention. TEST-TAKING HINT: The test taker must prioritize the interventions listed. All of the interventions could be addressed in option "3."

The hospice nurse is admitting a client. Which question concerning end-of-life care is most important for the nurse to discuss with the client and family? 1. Encourage the client and family to make funeral arrangements. 2. Assess the client's pain medication regimen for effectiveness. 3. Determine if the client has made an AD or living will. 4. Ask what durable medical equipment is in place in the home.

Answer: 3 1. The nurse could possibly help the family to guide them about the need for eventual arrangements, but it is not appropriate during the admission process. 2. The client may or may not have pain; nothing indicates pain is an issue in the stem of the question. 3. ADs provide guidance for end-of-life care; the nurse needs this information in order to plan the care per the client's wishes. 4. This could be determined, but the priority is knowing the client's wishes. TEST-TAKING HINT: The test taker should recognize timing when reading a stem or option in a question. "On admission," "every day," "every 2 hours" will help to determine a correct answer.

The hospice care nurse is conducting a spiritual care assessment. Which statement is the scientific rationale for this intervention? 1. The client will ask spiritual questions and get answers. 2. The nurse is able to explain to the client how death will affect the spirit. 3. Spirituality provides a sense of meaning and purpose for many clients. 4. The nurse is an expert when assisting the client with spiritual matters.

Answer: 3 1. The nurse is not able to provide all spiritual answers to the client. 2. The nurse can explain the physical aspects of death, but no one is able to tell the client with absolute knowledge what will happen to the soul or spirit at death. The beliefs of the client may differ greatly from those of the nurse. 3. Clients facing death may wish to find meaning and purpose in life through a higher power. This gives the clients hope, even if life on earth will be temporary. 4. The nurse is not an expert but should be comfortable in private beliefs to be able to allow the client to discuss personal beliefs and hopes. The experts would be chaplains and spiritual advisers from the client's faith. TEST-TAKING HINT: The test taker should recognize the nurse's expertise is not in the spiritual realm, although the nurse is frequently the one called on to perform the assessment and refer to the appropriate person.

The pregnant client asks the nurse about banking the cord blood. Which information should the nurse teach the client? 1. The procedure involves a lot of pain with a very poor result. 2. The client must deliver at a large public hospital to do this. 3. The client will be charged a yearly storage fee on the cells. 4. The stem cells can be stored for about 4 years before they ruin.

Answer: 3 1. There is no pain associated with storing cord blood. The blood is taken from the separated placenta at birth. From 40 to 150 mL of stem cells can be retrieved from the umbilical vein. 2. All hospitals that have an obstetrics department should be able to assist with the collection of stem cells. The client should notify the HCP to be prepared with the kit to obtain the specimens and to be able to send the stem cells to the Cord Blood Registry for processing and storage. 3. In private cord blood banks, there is an initial fee to process the stem cells and a yearly fee to maintain the stored stem cells until needed. Stem cells may be used by the infant in case of a devastating illness or can be donated at the discretion of the owner. In a public cord blood bank, there is no fee to store the cord blood, but the stem cells would be donated to anyone who matches. 4. This is true of stem cells that have been stored for more than 20 years. TEST-TAKING HINT: The test taker should recognize pain could not be associated with tissue that is no longer a part of the body.

The nurse is caring for clients on the medical floor. Which client should the nurse assess first after the shift report? 1. The client with arterial blood gases of pH 7.36, PaCO2 40, HCO3 26, PaO2 90. 2. The client with vital signs of T 99°F, P 101, R 28, and BP 120/80. 3. The client reporting pain at a "10" on a 1-to-10 scale but can't localize it. 4. The postappendectomy client with pain at a "3" on a 1-to-10 scale.

Answer: 3 1. These are normal arterial blood gases. 2. These temperature, pulse, and respiration rates are only slightly elevated, and the blood pressure is normal. 3. This is typical of clients with chronic pain. They cannot localize the pain and frequently describe the pain as always being there, as disturbing rest, and as demoralizing. This client should be seen, and appropriate pain-control measures should be taken. 4. This is considered mild pain, and this client can be seen after the client diagnosed with chronic pain. TEST-TAKING HINT: Options "1" and "2" could be eliminated because the values are within normal limits or only slightly above normal. Option "4" could be eliminated because 3 is low on the 1-to-10 pain scale.

The client with an AD tells the nurse, "I have changed my mind about my AD. I really want everything possible done if I am near death since I have a grandchild." Which action should the nurse implement? 1. Notify the health information systems department to talk to the client. 2. Remove the AD from the client's EHR and shred any paper documents. 3. Inform the client of the right to revoke the AD at any time. 4. Explain this document cannot be changed once it is signed.

Answer: 3 1. This department has nothing to do with the AD. 2. The most appropriate action would be for the nurse to have the client write on the AD that the document is revoked; the nurse cannot shred legal documents from the client's EHR. 3. The client must be informed the AD can be rescinded or revoked at any time for any reason verbally, in writing, or by destroying the AD. The nurse cannot destroy the client's AD, but the client can. 4. This is an incorrect answer because the client always has the right to a change of mind. TEST-TAKING HINT: Option "4" can be eliminated by remembering statements with absolutes should not be selected as correct answers unless the test taker knows for sure the answer is correct. The nurse should record in the EHR that the client has rescinded or revoked the document. Any paper copies of the AD should be returned to the client to destroy.

The male client diagnosed with chronic pain since a construction accident that broke several vertebrae tells the nurse he has been referred to a pain clinic and asks, "What good will it do? I will never be free of this pain." Which statement is the nurse's best response? 1. "Are you afraid of the pain never going away?" 2. "The pain clinic will give you medication to cure the pain." 3. "Pain clinics work to help you achieve relief from pain." 4. "I am not sure. You should discuss this with your HCP."

Answer: 3 1. This is a therapeutic response and the client is requesting information. 2. Pain clinics do not cure pain; they do help identify measures to relieve pain. 3. Pain clinics use a variety of methods to help the client to achieve relief from pain. Some measures include guided imagery, transcutaneous electrical nerve stimulation (TENS) units, nerve block surgery or injections, or medications. 4. This is not an appropriate answer, even if the nurse is not sure. The nurse should attempt to discover the information for the client and then give factual information. TEST-TAKING HINT: The test taker should answer a question with factual information. If the stem asks for a therapeutic response, then the test taker should choose one that addresses feelings.

The male client in the long-term care facility has been told that he will not live for many more months. The client has been estranged from his son for years. He tells the nurse that he could die a happy man if he could talk to his son just one more time. Which statement is the nurse's best response? 1. "You should not feel bad. Things will work out for the best before your death." 2. "What did you do to make your son not talk to you all this time?" 3. "If you would like, I can try to contact your son and ask him to come see you." 4. "Tell me more about being unhappy that you don't have a relationship with your son."

Answer: 3 1. This is false reassurance. 2. The blame for the lack of communication may not be the client's; it could be all on the son. This is an accusatory statement. 3. The nurse is asking permission to divulge the client's location and health status to the son; this is appropriate for complying with HIPAA and is addressing the voiced concerns of the client. 4. The nurse can perform an intervention that directly affects the client's situation. A therapeutic conversation might be used if the client's son is not willing to reconcile with the client. TEST-TAKING HINT: The test taker could eliminate option "1" because it is advising the client about how he should feel. Option "2" asks why and blames the client. Option "4" does not address the client's needs.

The family has requested a client diagnosed with terminal cancer not be told of the diagnosis. The client tells the nurse, "I think something is really wrong with me, but the doctor says everything is all right. Do you know if there is something wrong with me?" Which response by the nurse would support the ethical principle of veracity? 1. "I think you should talk to your doctor about your concerns." 2. "What makes you think something is really wrong?" 3. "Your family has requested you not be told your diagnosis." 4. "The doctor would never tell you incorrect information."

Answer: 3 1. This response does not support veracity. 2. This response does not support veracity. 3. The principle of veracity is the duty to tell the truth. This response is telling the client the truth. 4. This response does not support veracity. TEST-TAKING HINT: The test taker must know certain ethical principles, such as veracity, beneficence, nonmaleficence, fidelity, autonomy, and justice, to name a few. Without knowing the definition of veracity, the test taker would not be able to answer this question correctly.

The nurse is moving to another state, which is part of the multistate licensure compact. Which information regarding ADs should the nurse be aware of when practicing nursing in other states? 1. The laws regarding ADs are the same in all the states. 2. ADs can be transferred from state to state. 3. A significant other can sign a loved one's AD. 4. ADs are state regulated, not federally regulated.

Answer: 4 1. Individual states are responsible for specific legal requirements for ADs. 2. Moving from one state to another does not nullify or honor the AD; the nurse must be aware of the individual state's requirements. 3. Only the individual can complete and sign an AD. The significant other may be asked to implement the AD. 4. The state determines the definition of terms and requirements for an AD; individual states are responsible for specific legal requirements for ADs. TEST-TAKING HINT: The test taker should know the RN must obtain a copy of the Nurse Practice Act of the state being practiced in. The test taker should realize every state has different regulations regarding ADs and other healthcare issues. Option "4" is the only option that reflects this thought.

The nurse is presenting an in-service discussing do not resuscitate (DNR) orders and ADs. Which statements should the nurse discuss with the class? Select all that apply. 1. ADs must be notarized by a notary public. 2. The client must use an attorney to complete the AD. 3. Once the AD is written, it can be used for every hospital admission. 4. The HCP must write the DNR order in the client's EHR. 5. A DNR order must be included in the AD.

Answer: 3, 4 1. This is not true; someone who is not family or directly involved in the client's care must witness the AD, but the document does not always have to be notarized. The notary requirements vary by state. 2. This form can be filled out without the use of an attorney; copies of an AD can be obtained at hospitals or online from various sources. 3. The AD does not expire; therefore, it does not need to be updated with each hospital readmission. However, the client can change or cancel the AD at any time. In contrast, a DNR order must be written on each admission. 4. The HCP writes the DNR order in the client's EHR. 5. A DNR order does not have to be included in an AD. The client may use the AD form or may tell the HCP they do not want to be resuscitated. TEST-TAKING HINT: Options "1" and "2" are absolute, and unless the test taker knows for sure this is correct information, the test taker should eliminate them.

The client received a liver transplant and is preparing for discharge. Which discharge instructions should the nurse teach? Select all that apply. 1. The immune-suppressant drugs must be tapered off when discontinuing them. 2. There may be slight foul-smelling drainage on the dressing for a few days. 3. Notify the HCP immediately if a cough or fever develops. 4. The skin will turn yellow from the antirejection drugs. 5. Immunizations are recommended, but avoid live virus vaccinations.

Answer: 3, 5 1. The client must take an immune-suppressant medication forever unless a rejection occurs, and then the client would die without another transplant. 2. Foul-smelling drainage would indicate infection and is not expected. This would be an emergency situation. 3. Clients should be taught to notify the HCP immediately of any signs of an infection. The immune-suppressant drugs will mask the sign of an infection and superinfections can develop. 4. The skin turns yellow in liver failure; the antirejection drugs do not cause jaundice. 5. Clients should be instructed to get routine immunizations, such as the flu vaccine. Live attenuated vaccines are contraindicated, but some are currently under investigation by the U.S. Food and Drug Administration. TEST-TAKING HINT: Standard postoperative instructions include teaching the client to watch for any sign of an infection. Foul-smelling drainage is never normal.

The nurse is caring for five clients in different stages of the grieving process. Rank each client in order of the Kübler-Ross stages from first to last. 1. The hospice client who called his family to the room and said good-bye, then dismissed them and now lies quietly and refuses to eat. 2. The male client diagnosed with lung cancer tells the nurse, "If I can live long enough to walk my daughter down the aisle at her wedding, then I can deal with this cancer." 3. The 20-year-old female client after being told she has breast cancer tells the HCP, "I can't have breast cancer. I am too young." 4. The female client is refusing to get out of bed to go to chemotherapy treatments for cancer because she feels the treatment is hopeless. 5. The young man is punching the wall when told his father has just died.

Answer: 3, 5, 2, 4, 1 3. This client is experiencing the first stage of Kübler-Ross' stages of grief. She is in denial and experiencing avoidance and shock. 5. This client is experiencing the second stage of grief known as anger. 2. This client is trying to negotiate with his grief by trying to change the circumstances. This is the third stage of Kübler-Ross' stages of grief called bargaining. 4. This client is in the fourth stage of Kübler-Ross' stages of grief, which is depression, and experiencing hopelessness and withdrawal from others. 1. This client has accepted his imminent death and is withdrawing from his family. Acceptance is the last stage of Kübler-Ross' stages of grief. TEST-TAKING HINT: There are five stages to Dr. Elisabeth Kübler-Ross's grieving process, and some authorities list several more. The test taker should be familiar with the five stages of grief.

The nurse is assessing a client diagnosed with chronic pain. Which clinical manifestations should the nurse observe? 1. The client's blood pressure is elevated. 2. The client has rapid shallow respirations. 3. The client has facial grimacing. 4. The client is lying quietly in bed.

Answer: 4 1. Blood pressure elevates in acute pain. Chronic pain, by definition, lasts more than 6 months, lasts far beyond the expected time for the pain to resolve, and may have an unclear onset. Changes in vital signs result from the fight-or-flight response by the body. The body cannot maintain this response and must adjust. 2. Rapid shallow respirations might be attributed to acute pain if it was painful to breathe. The client diagnosed with a chest injury or pain will splint the area and slow the respirations or attempt to breathe shallowly and rapidly. 3. Facial grimacing will occur in acute pain and is an objective sign the nurse can identify. Clients with chronic pain may be laughing and still be in pain. Remember, pain is whatever the client says it is and occurs whenever the client says it does. 4. The client diagnosed with chronic pain will have adapted to living with the pain, and lying quietly may be the best way for the client to limit the feeling of pain. TEST-TAKING HINT: The test taker must be able to differentiate between acute and chronic pain. Options "1," "2," and "3" are objective symptoms of acute pain. If the test taker were aware of this, then choosing the only option left would be a good choice.

The client is dying and wants to talk to the nurse about heaven. Which is the nurse's best nursing action? 1. Make a referral to the chaplain to come to see the client. 2. Tell the client that nurses are not allowed to discuss spiritual matters. 3. Ask the client to describe heaven and hell. 4. Allow the client to discuss the beliefs about heaven.

Answer: 4 1. Chaplains work with all faiths and are spiritual advisers. If the nurse feels comfortable with discussing heaven, and if the client wishes to talk with the nurse, it is appropriate. 2. Nurses are not prohibited from discussing spiritual issues with a client; the nurse should not challenge the client's personal beliefs. 3. Hell is not what the client wants to talk about. 4. The nurse should allow the client to verbalize feelings regarding what to expect when death occurs. TEST-TAKING HINT: The nurse student is taught in first-level courses to allow the client to verbalize feelings; the test taker should recognize this as basic nursing skills.

The client asks the nurse, "When will the durable power of attorney for health care take effect?" On which scientific rationale would the nurse base the response? 1. It goes into effect when the client needs someone to make financial decisions. 2. It will be effective when the client is under general anesthesia during surgery. 3. The client must say it is all right for it to become effective and enforced. 4. It becomes valid only when the clients cannot make their own decisions.

Answer: 4 1. It is a power of attorney executed by a lawyer that allows a delegated other person to make financial decisions. That document has nothing to do with a durable power of attorney for health care. 2. The client has not lost the capacity to make decisions; therefore, a durable power of attorney cannot be used by the assigned person to make decisions. 3. The client must not be able to make decisions before this document can be used. 4. The client must have lost decision-making capacity as a result of a condition that is not reversible or must be in a condition that is specified under state law, such as a terminal, persistent vegetative state; an irreversible coma; or as specified in the AD. TEST-TAKING HINT: The test taker should not confuse a power of attorney and a durable power of attorney for health care. These are two separate, yet very important, documents with similar names.

The nurse is caring for a dying client and the family. The male client is a practicing Muslim. Which intervention should the female nurse implement at the time of death? 1. Delay notification of the Islamic funeral home to allow for bedside death rituals. 2. Call the client's imam to perform last rites when the client dies. 3. Place incense around the bed, but do not allow anyone to light it. 4. Do not touch the body, and have family members perform care.

Answer: 4 1. Muslim burials are often performed quickly after death, sometimes on the same day. The nurse should not delay notification of the Islamic funeral home. 2. Last rites are performed by a Catholic priest, not a Muslim imam. 3. Many Hindus use incense to pray, but Muslims typically do not. 4. If possible, the male client should not be handled or washed by a female nurse for cultural sensitivity. Often, members of the Muslim community wish to make arrangements for the washing, shrouding, and burial of the client according to Islamic requirements. TEST-TAKING HINT: The question requires culturally sensitive knowledge. The test taker must be aware of the different beliefs of the clients being cared for.

Which tissue or organ can be repeatedly donated to clients needing a transplant? 1. Skin. 2. Bones. 3. Kidneys. 4. Bone marrow.

Answer: 4 1. Skin is taken from cadaver donors, so it is given once. 2. Bones are taken from cadaver donors, so it is given once. 3. A kidney can be donated while the donor is living or both can be donated as cadaver organs, but either way, the donation is only once. 4. The human body reproduces bone marrow daily. There is a bone marrow registry for participants willing to undergo the procedure to donate to clients when a match is found. TEST-TAKING HINT: The test taker could eliminate option "3" because the stem asks for repeated times and the client cannot live without kidney function. The client would have to be placed on dialysis or die.

Which document is the best professional source to provide direction for a nurse when addressing ethical issues and behavior? 1. The Hippocratic Oath. 2. The Nuremberg Code. 3. Home Health Care Bill of Rights. 4. ANA Code of Ethics.

Answer: 4 1. The Hippocratic Oath is the oath taken by medical doctors. 2. The Nuremberg Code identifies the need for voluntary informed consent when medical experiments are conducted on human beings. This source does not provide direction for the nurse addressing ethical issues. 3. This document informs clients and families receiving home health care of the ethical conduct they can expect from home care agencies and their employees when they are in the home. This source is not the best professional source for all nurses. 4. The American Nurses Association (ANA) Code of Ethics outlines to society the values, concerns, and goals of the nursing profession. The code provides direction for ethical decisions and behavior by emphasizing the obligations and responsibilities that are entailed in the nurse-client relationship. TEST-TAKING HINT: The test taker must be aware of the word "best" to be able to answer this question. All four answer options may or may not be potential answers, but the test taker must select the option that addresses all nurses. Option "3" should be eliminated as a possible answer because it addresses only home health care.

The nurse and an unlicensed assistive personnel (UAP) are caring for a group of clients in a pain clinic. Which intervention would be inappropriate for the RN to delegate to the UAP? 1. Assist the client diagnosed with intractable pain to the bathroom. 2. Elevate the head of the bed for a client diagnosed with back pain. 3. Perform passive range of motion for a bedfast client. 4. Monitor the potassium levels on a client about to receive medication.

Answer: 4 1. The UAP could perform this function. 2. The UAP could perform this function. 3. The UAP could perform this function. 4. The nurse should monitor any laboratory work needed to administer medication safely. TEST-TAKING HINT: The rules for delegation state assessment, teaching, evaluating, or anything requiring nursing judgment cannot be delegated.

The mother of a 20-year-old male client receiving dialysis asks the nurse, "My son has been on the transplant list longer than that woman. Why did she get the kidney?" Which statement is the nurse's best response? 1. "The woman was famous, and so more people will donate organs now." 2. "I understand you are upset your son is ill. Would you like to talk?" 3. "No one knows who gets an organ. You just have to wait and pray." 4. "The tissues must match or the body will reject the kidney and it will be wasted."

Answer: 4 1. There is a feeling during times of stress that organs may be distributed unfairly. Tissue and organ banks use the United Network of Organ Sharing (UNOS) to be as fair as possible in the allocation of organs and tissues. Organs will be given to the best match for the organ in the community where the donor dies. If no match is found in that area, then the search for a human leukocyte antigen (HLA) match will be expanded to other areas of the country. The recipient is chosen based on the HLA match, not fame or fortune. 2. The client is asking for information, which the nurse should provide. 3. There is a definitive method of allocation of organs. 4. HLAs are the principal histocompatibility system used to match donors and recipients. The greater the number of matches, the less likely the client will reject the organ. Different races have different HLAs. TEST-TAKING HINT: Option "2" can be eliminated because the client asked for information. Option "1" can be eliminated because the statement supports an unethical situation.

The nurse is caring for a client who is confused and fell, trying to get out of bed. There is no family at the client's bedside. Which action should the nurse implement first? 1. Contact a family member to come and stay with the client. 2. Administer a sedative medication to the client. 3. Place the client in a chair with a sheet tied around him or her. 4. Notify the HCP to obtain a restraint order.

Answer: 4 1. This action should be taken, but this is not the first action to keep the client safe. 2. This is a form of chemical restraint, and the nurse must have an HCP's order. 3. This is a form of restraint and is against the law unless the nurse has an HCP's order. 4. The nurse must notify the HCP before putting the client in restraints. Restraints are used in an emergency situation and for a limited time and must be for the protection of the client. TEST-TAKING HINT: The test taker must realize that when the stem asks which action is first, more than one option may be appropriate for the situation, but only one is implemented first. Restraining a client is considered battery and is against the law unless the client is a danger to self and there is an HCP's order.

The nurse must be knowledgeable regarding ethical principles. Which is an example of the ethical principle of justice? 1. The nurse administers a placebo, and the client asks if it will help the pain. 2. The nurse accepts a work assignment in an area of inexperience. 3. The nurse refuses to tell a family member the client has a positive HIV test. 4. The nurse provides an indigent client with safe and appropriate nursing care.

Answer: 4 1. This addresses the ethical principle of veracity. Should the nurse tell the client truthfully a placebo will not help the pain? 2. This is an example of nonmaleficence, the duty to prevent or avoid doing harm, whether intentional or unintentional. Is it harmful for the nurse to work in an area of inexperience? 3. This is an example of the ethical principle of fidelity, the duty to be faithful to commitments. It involves keeping promises and information confidential and maintaining privacy. 4. Justice involves the duty to treat all clients fairly, without regard to age, socioeconomic status, or any other variables. Providing safe and appropriate nursing care to all clients is an example of justice. TEST-TAKING HINT: The test taker must be knowledgeable regarding ethical principles; they are part of the NCLEX-RN®. The word "justice" should make the test taker think about fairness, which might lead the test taker to select option "4" as the correct answer. The test taker should not automatically think, "I don't know the answer." Think about the words before selecting the correct answer.

The client diagnosed with end-stage congestive heart failure and type 2 diabetes is receiving hospice care. Which action by the nurse demonstrates an understanding of the client's condition? Select all that apply. 1. The nurse monitors the blood glucose four times a day. 2. The nurse keeps the client on a strict fluid restriction. 3. The nurse limits the visitors the client can receive. 4. The nurse brings the client a small piece of cake. 5. The nurse reports uncontrolled pain to the HCP.

Answer: 4, 5 1. This would be basic care, but it does not indicate the nurse is aware of the client's terminal prognosis. 2. This does not indicate an understanding of the client's terminal status. 3. The nurse should encourage visitors. There is not much time left for making memories, which will assist those left behind in dealing with the loss and allow the client time to say good-bye. 4. The client may have diabetes, but the client is also terminal, and allowing some food for pleasure is an understanding of the client's life expectancy. 5. The nurse should inform the HCP of a client who has pain that is not controlled. There is no basis for fear of this client becoming addicted to pain medications with an understanding of the client's life expectancy. TEST-TAKING HINT: This question requires the test taker to look not only at the disease processes but also at the descriptive words "end-stage" and "hospice" and ask, "What do these descriptors mean to the disease process?" Not limiting the client in small ways indicates the nurse is aware the client has a limited time to live. Pain control is a priority for hospice clients. Federal guidelines require hospice to make every reasonable effort to control a client's pain.